The Secret of Good Therapy – Part 2

imagesNow I’m not trying to punt my own profession here, but the great advantage of hypnotherapy, which relies on getting the client to relax and find a comfortable ‘space’ to discuss things which would otherwise be difficult, is that it provides a comfort zone that allows the client to do just this. Therefore, it is quicker and cheaper than hours and hours of psychoanalysis. Freud abandoned hypnosis because like many others of his time, he was still searching for the ‘trance’ – the elusive, magical state of mind that only the very suggestible can achieve. In modern hypnotherapy, we don’t worry about trances and ‘altered states of consciousness,’ we just get the client to focus their attention on what they already know deep down to be the truth, and then take it from there.

At the same time as getting the client, or patient if you like, to ‘freewheel,’ analysts concern themselves with trying to spot any ‘resistance’ such as a reluctance on behalf of the client to talk about certain things or the client trying to change the subject, or the client cracking jokes (I’d be a terrible patient!) The general idea being that resistance is the client’s way of stopping painful thoughts coming to the surface.

Unfortunately, this is actually bollocks. Any hypnotherapist knows that clients are perfectly willing to open up about their innermost thoughts and problems to a perceived professional. My experience, and that of most of the therapists I have spoken to, don’t worry about this. The clientknows what the problem is, and even if they don’t want to talk about it (which sometimes they don’t) it makes no difference to the positive outcome of the session: so long as the client knows what it is, I don’t necessarily have to know – so long as they know. I have conducted entire sessions where I have absolutely no idea what the client’s problem is, but by the end of the session, they feel a lot better about it and are visibly relieved, expressing their thanks by means of a cash payment. So… Freud had it all wrong. Not all his fault of course, after all, he was a pioneer in an as yet not nearly understood field, but maybe he should have laid off the coke a bit.

It was Carl Jung who introduced the technique of Word Association. As with Freud’s free association, the general idea is to say out loud the first word that comes into your head, the theory being that from your random words, the analyst can work out what is troubling you. This is worse than some sort of ridiculous guessing game, it’s complete and utter folly.

Another beardy-weirdy way of doing it is by looking for Psychological Cues – blushing, turning pale, sweating, changes in breathing or changes in voice pitch. Fortunately, this method has already been exposed as being worse than useless, not only because environmental influences can affect a client’s physical responses, but because it really is no more revealing that Darth Vader’s truth ray.

The theory is that once the data has been conscientiously written down; once the unconscious conflict has been made conscious, the analyst can then go on to the business of interpreting what has been made apparent. The client then transfers (through a process not surprisingly called Transference) their feelings of frustration, jealousy, hostility or hatred, or love and affection, onto the analyst. Freud believed that by doing this, even disorders such as schizophrenia and depression could be cured. He really was nuts, you know. Shouldn’t have done all that coke. The only real way to cure these kind of issues, is by getting the client to understand or accept that they are distressed (easy) and then show them how to create emotional distance from all the negative thoughts, feeling and emotions that have been holding them back (takes about 10 minutes on a bad day!)

Nonetheless, what the analyst is doing is getting the client to gain Insight into their own particular bugbear and be mindful of it’s emotional content, thereby gaining the ability to control it. Or perhaps re-taking control of their lives would be a better way of putting it. Or maybe, re-taking OWNERSHIP of their lives…

Dream interpretation (another Freudian pseudo-psychobabble) is supposed to indicate a client’s Wish Fulfillment. Freud believed that dreams were symbolic and reveal what the client really wants. For example, a dream about eating a giant marshmallow could be the mind’s symbolic way of saying ‘I want to have sex with a very large woman.’ Or maybe not.

The truth of the matter is that any symbolism in dreams means whatever the client wants them to mean. Symbolism is unique only to that one client and is of no use whatsoever to anyone else. Again, that is all that is necessary for both client and therapist to move swiftly on.

True, hypnosis is no better at revealing information. But that is not what hypnosis is there for. Hypnosis is about the solution to the problem and getting the client to effect change, not picking over the debris of some repressed (or false!) memory. (See related articles.) But, the main problem I (and most others in the know) have with Freud is his obsession with aggressive and sexual impulses, characteristic of the Id, if indeed the Id exists in the first place – we only have Freud’s word for it.

So, how many psychotherapists does it take to change a light bulb? Answer: Only one, and only if the light bulb wants to change. And therein lies the weakness of this whole business. You can take the horse to water, but you can’t make it drink. ALL psychotherapy is dependent on the client’s willingness to identify and face up to their shortcomings, and take steps to effect change. Today, most therapists are dismissive of Freud’s psychodynamic therapies, if only because things have moved on considerably: there are now faster, more efficient, more targeted therapies on offer. Freud, I’m afraid, has passed his sell-by date.

Behaviour Therapy aims to literally change a person’s behaviour. No big surprise there! Gone is the time-wasting process of delving into a client’s unconscious. Instead, Behaviour Therapy means what is says on the tin: Bad or undesirable behaviour is unlearned and new, good behaviour is learned – just like the naughty pre-schooler in kindergarten, but more expensive.

The techniques of behaviour therapy were covered in detail in the chapter ‘A Quick Psychology Lesson’ in All In The Mind. I do not propose to regurgitate the whole thing here – suffice it to say that the psychology lesson isn’t really that quick and it was considerably more detailed than can adequately be reproduced on a web page. Still worth a look though.

Cognitive Therapy, or Cognitive Behaviour Therapy (CBT) is based on the premise that mental disorders are the result of faulty thinking. It is useful for dealing with a variety of disorders, including, but not limited to, phobias bulimia, anorexia, depression, to name but a few. Some say it can also be effective in dealing with chronic fatigue, but I’d watch out for that one if I were you – how would you know that the chronic fatigue you are trying to cure is not caused by chronic heart disease…eh?

Anyway, the basic premise is that the individual is not disturbed by actual things or events, but by their perception of things or events. In other words, the way they view things or events. Albert Ellis put the process into three easy stages:

A)    Activating event: example: I was expecting a phone call from my friend – she always calls on Friday, but she hasn’t called in two weeks!

B)    Consequence:  I’m very worried that I have said or done something that has upset her and she’s fallen out with me.

C)    Belief system: I’m a useless person – no one likes me!

In reverse, the theory is that by changing the belief system, we can go on to deal with the emotional problem tied to it, and thereby dismiss as irrelevant or inconsequential the activating event, after all the friend might be away on business or visiting her parents! This sort of rationalization with clients is easy once you know how!

Many people hold onto irrational beliefs, and again, this is a subjective experience and is nearly always the result of negative attitudes toward oneself. Some of these negative beliefs are extreme enough to be considered Paranoia. This is a difficult rut to get out of. Nonetheless, there is an answer.

Try asking the client to imagine that they can have a conversation with someone they either like, admire, or respect. It doesn’t matter whether or not the client knows them or whether or not they have even met them, because what we are about to do is play a game of ‘make-believe.’ The person the client chooses could be anyone – maybe a loved and respected great-aunt, or a film star, or sporting star – it could be a best friend or a family member, even someone they haven’t seen for years.

Now, don’t need to know who that person is, I really don’t. But what the client can now ‘make-believe’ is this: if you were somehow able to have a conversation with that person, what advice do you think they would give you? This is a way of getting the client to do the work for you – the client is able to give themselves the advice that suits them best – the advice that deep down they always knew to be the truth! (Barrie St. John showed me this one and it’s brilliant in its simplicity. I use it a lot with clients now and it’s really effective.)

This technique covers a multitude of problems. Above all, it encourages the client to take a more realistic approach, even if the advice is not always what they want to hear! Like the rest of us, clients need to face up to some of the harsh realities of life. The secret lies in our ability to beobjective rather than subjective. We have all had friends who have had problems, and it’s always so easy to see the solutions to those problems when you’re looking at the problem from outside the bubble. Not so easy though to see the solutions to our own problems – because we are too close to them, trapped inside the goldfish bowl – a classic case of not being able to see the wood for the trees really.

Cognitive Restructuring Therapy is another variation on the theme. Developed by Aaron Beck, it encourages clients to think of alternative explanations to perceived problems or threats, thereby regaining control of their emotions. For example:

Interpretation 1: the cat has not returned home; maybe it’s been run over;

Interpretation 2: the cat has not returned home; maybe it has found a mouse-hole to play with.

Beck says that excessive criticism from parents or teachers during childhood and adolescence can lead to depression later on, through a triad of inter-related negative beliefs:

·      The self-view feels worthless, undeserving of love, helpless and unable to ever be happy;

·      The world-view is that life is always too demanding with too many obstacles;

·      The future view confirms these negative feelings – that there is no likelihood of improvement and no hope…

This is obviously a distorted and unrealistic outlook. Nonetheless, once these feelings take a hold, they are almost impossible to shake off. Almost impossible…

Cognitive Restructuring teaches the client how to think about their thinking (this is also known as mindfulness) and encourages them to correct the faulty thinking that created the problem in the first place. It’s simple enough to do. First, the client learns to monitor his or her own negative thoughts. Next, they rationally and logically examine the probabilities (the cat has disappeared before, but always comes back in the end.) Finally, the client substitutes the more realistic explanation, In this way, the client learns to first identify, and then alter the negative beliefs that lead to the distortion of reasonable expectation.

There is one small flaw in this plan and that is that the therapist is often tempted to offer guidance to the client. According to the rules, this is something the therapist should not allow themselves to do (reference Carl Rogers.) But using this particular technique, there is always the danger… Which brings me to my actual point, which is that some of the therapists I have met are actually bonkers – stark staring mad some of them! I don’t know why it is, but the alternative therapy business seems to attract some very odd types. It’s a shame there isn’t more regulation.

There is a common theme running through all these therapeutic techniques, and that is; Attributional Bias, which is all to do with how the client attributes the problem. Most people feel that any successes in their lives are mainly due to their own efforts (with maybe a sprinkling of good fortune, such as being in the right place at the right time.) Failures however tend to be attributed to outside influences; other people’s faults or unexpected environmental influences such as earthquakes or getting mugged on the way home from the railway station.

People in depression don’t see it like that. Depressives see it in quite the opposite way; they attribute their failures to their own shortcomings and successes caused by factors beyond their control.

What the therapist has to work out are ways of changing this mindset. I have found lists, tables, diagrams, charts, all very helpful. Clients make these themselves with no assistance or interference from me, laying out in a legible manner their successes and failures, and what they were all down to. I have found this to be an extremely useful exercise because it gives the client something tangible to look at – a pictorial representation of their beliefs – and is a brilliant way of helping them to decide what needs to be done! Once that part of the therapy is accomplished, we can then move forward, getting the client to use their own logic and intelligence to improve their self-esteem, confidence and of course their overall performance. It takes a little time and some patience, but it can be done. I have found that the client starts to see it soon after they start the exercise.

In the end, it all comes down to the power of positive thinking! As Carl Rogers said, the individuals have within them vast resources of self-understanding that can alter their self-concept, attitude, and self-directing behaviour. These resources can be tapped if a definable set of goals can be presented to, and agreed on, by the client.

OK, so if you have read some of these articles already, you will by now realize that Carl Rogers is a something of a hero of mine, and I admit it. I have found that his idea of Person-Centred Therapy is simply the best approach. It’s non-directive and non-judgmental; it makes perfect sense and seems to work every time. Maybe it is because it forces the client to most of the work! At the very least, it certainly encourages the client to face reality, something they have been putting off for too long! The other point to bear in mind is that although the therapist must never give advice, it’s OK for the therapist to agree with and support the client when the client gets it right.

I can throw out a list of words and phrases like unconditional positive regard, genuineness, empathy, authenticity, realness, transparency, congruence, honesty, openness, acceptance, respect, understanding,but I’m not going to, although all those terms precisely describe what the relationship between therapist and client should be like. You must always care about your client; if you don’t, you will fail, because the client always picks up on it. Lets face it; you know when someone is trying their best for you the same as you can tell when someone doesn’t give two hoots. It’s all about building a trusting relationship. Furthermore, we have two ears and only one mouth, so we should listen twice as much as we talk. So what are we really there for? We simply help the client make their own decisions about their present and future situation.

Now the Gestalt Therapists might want to start throwing in their ten-pence worth at this point. Gestalt simply means ‘wholeness’ and as far as the people in therapy are concerned, it can include factors like diet, social life, who your friends are, the sort of entertainment you prefer, even the amount of natural light you are exposed to – anything in fact that might have a bearing on your general well-being.

Psychologist Fritz Perls used all sorts of role playing (acting out) games to help clients deal with ‘unfinished business.’ These amateur dramatics are sometimes useful in that they attempt to put the client in someone else’s shoes. It’s always healthy when individuals can see someone else’s point of view. If a client’s behaviour is irresponsible, it might be possible to Amplify that behaviour to such an extent that the client starts to see how ridiculous, childish or harmful it really is.

Perls also stressed the usefulness of concentrating on the present and the future rather than what is in the past, getting them to focus on what they have rather than what is absent. Do I need to flog this point? Last but not least, clients shouldn’t try to be someone else – bad news for the NLP enthusiast. All this modeling and mirroring does no good; pretending to be someone or something you’re not is more stressful that it’s worth. And a bit sad… Just be yourself. Honestly, it’s a lot easier.

So, to sum up, here is a quick summary of 10 things we need to get the client to do:

1.     take responsibility for their own self, their actions and thoughts;

2.     become independent and self governing;

3.     exercise their own conscious intention;

4.     make ethical and moral choices;

5.     confront the anxieties and disappointments that are part of everyday life;

6.     move beyond their isolated, lonely, self and seek the company of others; in other words, make some friends;

7.     engage in loving relationships (not you, Oedipus!)

8.     get involved in some creative activity – there are plenty of opportunities to do this; dance classes, art classes, film clubs, musical and dramatic societies etc; above all, don’t just sit at home in front of the idiot lantern all the time!

9.     Get together with someone else, or better still, a group of people and invite them to go rock-climbing or paintball shooting or something.

10.  Read Dale Carnegie’s books How to Win Friends and Influence People and How to Stop Worrying and Start Living. Honestly, it’s all in there!

Throughout all this therapy stuff, Visualization is the most powerful tool. It helps people enhance their performance in sport, music, in the workplace, in relationships… need I go on? And in case you didn’t realize it, Just being able to talk to someone is HUGELY therapeutic… and beneficial.

For more information on hypnotherapy, read All in the Mind – Hypnosis, Suggestion and the New Mesmerists. Available from this website.

Copyright Andrew Newton 2016. All rights reserved.